Clinical Analysis Of85Patients With Acute Ischemic Posterior Circulation Stroke After Endovascular Treatment

Objective:To analysis the therapeutic effect and complications of intra-arterialthrombolysis and assisted mechanical recanalization therapy of acuteischemic posterior circulation stroke.Materials and Methods:For recent5years We retrospectively analyzed85cases of patientswith cerebral infarction in posterior circulation caused by vertebrobasilarocclusion,57cases with pure arterial thrombolytic therapy, andthrombolysis combined with mechanical recanalization in28cases. Weselected fifty patients as a control group who also caused byvertebrobasilar artery occlusion and were considered to have been treatedconventionally if they had not received any specified treatment, or if theyhad been treated with antiplatelets, anticoagulation, or a combination ofthe two during the time period studied. In the endovascular treatmentpatients were divided into two groups: somnolence group and comagroup, somnolence group included patients with consciousness ofwakeness and somnolence; We classified vascular recanalizationaccording to Thrombolysis in Myocardial Infarction (TIMI), TIMI score0~1point defined as bad,2~3as good; Clinical outcome was assessedin90d after surgery,according to the modified Rank (mRS) score.Wedefine0to2points as good,3to5points as poor,and6points as death. Results:There were no significant difference between the three groups ofpatients with cerebrovascular disease risk factors. Assessed by DSAangiography before the end of interventional operation, arterialrecanalization rate of thrombolysis alone group (TIMI≥2) was43.8%, andmechanical recanalization group was78.6%(p＜0.01).They hadsignificant difference. The rate of good prognosis in intraarterialthrombolysis, mechanical recanalization group, and conventionaltreatment group after90d were17.5%（10/57）、28.6%（8/28）and4%（2/50），mortality rates were66.7%（38/57）、53.6%（15/28）and86%（43/50）. Compared with the control group, good prognosis rate inarterial thrombolysis group, thrombolysis combined with mechanicalrecanalization group had significant difference (p=0.03; p＜0.01);mortality rates in arterial thrombolysis group, thrombolysis combinedwith mechanical recanalization group had significant difference (p=0.03;p＜0.01). Good prognosis rate and mortality rate in90d betweenintraarterial thrombolysis group and mechanical recanalization groupwere not significantly different (p=0.26; p=0.27). Of the patients in thewere all endovascular treatment group, the rate of good prognosis within6hours of onset and more than6hours were25.7%(9/35) and18.0%(9/50)，P=0.39; the rate of good prognosis in conscious and sleepinessgroup and coma group were39.5%（15/38）and6.4%（3/47），p＜0.01;the rate of good prognosis in recanalized and nonrecanalized patientswere31.9%（15/47）and7.9%（3/38）, p=0.01. There were4patients withcerebral hemorrhage after pure arterial thrombolytic therapy, but no onedied. Conclusion:Pure arterial thrombolysis, thrombolysis combined with mechanicalrecanalization could significantly improve favorable prognosis and reducethe mortality rate in patients with cerebral infarction due tovertebrobasilar occlusion in posterior circulation; Assisted mechanicalrecanalization of occluded vessels can improve the recanalization rate ofvertebrobasilar artery; assisted mechanical recanalization may improvethe curative effect of patients who have accepted pure arterialthrombolytic therapy with poor effect; the states of consciousness onsetwere closely related with the prognosis; the main causes of death inpatients are cerebral infarction and clinical complications.